March 29, 2010

Who Has Time To Read?

The NY Times has a story on the same toic as my endless post below, namely, does the new health care reform actually assure that all children with re-existing conditions can not be denied coverage?

I said that the answer is no (insurers can still deny coverage outright), that the text of the bill is clear, that this does not lend itself to a regulatory solution but will require new legislation, and that the confusion has been driven by people, especially Barack Obama, who are hung up on speaking English rather than Insurance-ese.

The Times provides a new direction - apparently insurance company legal eagles agree with me that they can still deny coverage, but now Congressman are focusing on their new ESP legislative approach - the bill means what they thought it meant and wanted to it to mean, not what they wrote:

The authors of the law say they meant to ban all forms of discrimination
against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems,
leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was
to provide those youngsters with access to insurance and to a full
range of benefits once they are in a health plan.

If you read my long post you will realize the absurdity of that claim. Just for starters, "pre-existing condition exclusion" has a statutory definition in each state and in the Public Health Service Act; it doesn't just mean whatever some committee member thinks it means.

The new bill had four sections which collectively provided protections for people with pre-existing conditions starting in 2014. These sections included Sec. 2702, which requires insurers to issue to anyone in their region; Sec. 2703, which obliges insurers not to restrict renewals; Sec. 2704, which bars "pre-existing condition exclusions such as "we will cover everything except bills related to your ongoing cardiac condition", and Sec. 2705, which requires fair pricing (no awards for the healthy or surcharges for the sick). All these sections are effective in 2014.

But even though all four sections are needed to provide full protection for people with pre-existing conditions, Congress only moved up the effective date of Sec. 2704 to 2010, for children under 19. That is hardly meaningless, since lots of kids are enrolled under their parent's employer group plans and subject to HIPAA exclusion periods as long as 18 months.

But accelerating only Sec. 2704 could never have been mistaken for a comprehensive attempt to protect all children, including the children of the self-employed. Either Congress needs to learn to write bills (possible) or they need to admit that this was not an error; their hype got ahead of reality.

I think Dems will prefer to blame Evil Insurance Companies rather than admit that they have gotten trapped by Obama's over-selling of the bill.

For a smidgen of history, here is a Senate bill, the Children's Health Protection Act of 2009 (S643), offered a year ago by Senator Lautenberg and others. It bars pre-existing condition exclusions in the group and individual market but does not include a must-issue provision, a must-renew provision, or anything about fair pricing. What is his goal? Let's ask the Senator:

Approximately 20 percent of school-aged children suffer from a chronic
disease including cancer, diabetes, asthma and heart disease. These
chronic diseases are frequently considered pre-existing conditions for
the purposes of health insurance coverage. The Health Insurance
Portability and Accountability Act of 1996 limited when insurance
companies could deny children health coverage due to a pre-existing
condition. However, a loophole in the law permits an insurance company
to limit coverage to a child who goes without health coverage for more
than 63 days.

The Children’s Health Protection Act of
2009 will close that loophole and prohibit insurers from imposing
pre-existing condition limitations on children under the age of 25.
This bill is aimed at helping the nine million American children who are
uninsured obtain the insurance they need to ensure prompt treatment for
their chronic conditions. In addition, it would potentially help
millions of children who are at risk for becoming uninsured if their
parents lose their job and health insurance in this economic crisis.

So he was going to close a HIPAA loophole. But of course, lots of people who lack insurance for themselves or their kids are not covered by HIPAA.

Lautenberg had originally considered "children" to be anyone under 25; his concept was adopted into the larger reform just passed, with the age reduced to 19:

Provisions that Sen. Lautenberg inserted in the
legislation will help make health care more affordable in high cost of
living states such as New Jersey and more widely available to children
with pre-existing conditions throughout the country.

Sen. Lautenberg’s “cost of living” amendment will require
the Administration to assess a cost of living adjustment to help ensure
fair health care subsidy levels for high cost of living states such as
New Jersey. Another provision that Sen. Lautenberg fought to include in
the bill will eliminate pre-existing condition exclusions for children
under the age of 19. The provision aims to help some of the nine
million uninsured American children obtain the insurance they need to
gain access to prompt treatment for their chronic conditions.

Earlier this year, Lautenberg introduced the Children’s
Health Protection Act (S. 643) to address this issue. An
estimated twenty percent of school-aged children suffer from a chronic
disease such as diabetes or cancer. These chronic diseases are
frequently considered pre-existing conditions for the purposes of health
insurance coverage. Currently, insurance companies can deny or limit
coverage to children with pre-existing conditions if their family has
been without health insurance coverage for more than two months.

That is where this provision came from. It never included "Must Issue" or "Must Renew", but did enhance HIPAA a bit. For Dems to pretend otherwise at this late date is disgraceful, but predictable.

FWIW: Last December when the Dems were taking up the manager's amendment which incorporated this "pre-existing conditions exclusion" fix it was not a Top Three selling point. Now the White House has it at number one, mainly because the White House is describing something not in the bill.

Guaranteed issue doesn’t mean a whole lot on its own without
accompaniment with some form of community rating. Otherwise, the
insurer can increase premiums to such a degree for the particular family
that they wouldn’t be able to afford insurance without keeping the
child off the policy.

Top Democrats may be outraged by the insurance industry’s
intransigence, but nowhere in the law – to my knowledge – did they add
any community rating language to cover this initial guaranteed issue for
children. There is modified community rating for all along with
guaranteed issue when the exchanges start up in 2014.

...The guaranteed issue for children provision came into the Affordable
Care Act late in the game, and does not seem to have been well
thought-out.

I dispute his characterization of the "no pre-existing condition exclusion" as guaranteed issue, and I think the concept did have a year-long history as the Lautenberg bill, but I like his point that the bill just doesn't say what it needs to say to get Dems where they claim to be.

IS EZRA KLEIN STILL DUCKING THIS? Last week in an on-line chat the WaPo's health care sage parroted the White House line:

New York, NY: Hi Ezra: I am an emergency physician in New York and
have been following your reporting with great interest. Many of my
patients are asking me about the future of "pre-existing conditions" and
denial of coverage to children and adults due to various illnesses. Can
you tell me when according to this legislation, insurance companies
will no longer be able to deny coverage to children and adults with
pre-existing conditions?!

Sincerely, Boris Markovich MD

Ezra Klein: Yep. For children, it's kicks in a couple of months from
now. For adults, it's not until 2014.

It looks like the Obama administration will issue some regulations
saying that their view is that the language involves both access to
insurance and the benefits kids get when they're insured, but it's not
clear whether that'll matter (some experts think it will,
but I'm skeptical, particularly if insurers want to evade it). Another
option would be to pass another bill strengthening the benefit, though
Republicans might filibuster that. The likeliest outcome, I think, is
that this early deliverable -- like most of the early deliverables -- isn't worth much, and the bill really goes into effect in 2014.

I can summarize the expert opinion to which he links - it would be really great if insurers paid for these kids, there can't be many and it won't cost much, Congressional intent can be inferred from how they promoted the bill and not how they wrote it, so let's just go for it. Wow.

I especially love this:

Because §2704 is intertwined with §2702’s availability provisions as a result of the structure of §1201 (indeed, non-discrimination in coverage and benefits has meaning only in the context of insurance enrollment), §2704 as amended has meaning only in the context of enrollment. In other words, the advance protections given child enrollees under the PPAC have meaning only in the case of children who are in fact able to enroll in coverage. One thus sees in PPAC §10103 a clear Congressional intent that in the case of children, the Act’s non-discrimination protections become effective in their entirety within 6 months of the date of enactment.

Right. Set against that is that Congress has a specific provision for enrollment and they did not accelerate that to cover children in 2010. However, what they did accelerate is perfectly meaningful in the context of employer group insurance, where the parent cannot be turned down and the only question is to what length of HIPAA-type exclusion period might the child be subject.

As to Congressional intent, Sen. Lautenberg intended to close a HIPAA loophole, not solve the problems of people not covered by HIPAA.

An estimated twenty percent of school-aged children suffer from a chronic disease such as diabetes or cancer.

CounterPoint:In the United States in 2007, approximately 10,400 children under age 15 were diagnosed with cancer and about 1,545 children will die from the disease. Although this makes cancer the leading cause of death by disease among U.S. children 1 to 14 years of age, cancer is still relatively rare in this age group. On average, 1 to 2 children develop the disease each year for every 10,000 children in the United States.
...
The rate of new cases among youth was 19 per 100,000 each year for type 1 diabetes and 5.3 per 100,000 for type 2 diabetes.

'Fair' pricing? Fair to whom? Someone has to pay for the cost. The healthy will be overcharged and those with pre-existing conditions who never bought insurance will be undercharged.

What else is slated for "fair" treatment in the future? Well, it looks like housing is already there...don't make mortgage payments and get a reprieve from payments and/or your principal reduced. Maybe job pay is next. Everyone who works for the same company or industry gets paid exactly the same. It's only "fair".

Didn't the left go nuts (yeah, I know redundant) when Victoria Toensing argued the intent behind the Intelligence Protection Act was not for people like Plame? They beat her up pretty good for making the argument that she knew what the intent of the law was.

Famed global warming activist James Schneider and a journalist friend were both found frozen to death on Saturday, about 90 miles from South Pole Station, by the pilot of a ski plane practicing emergency evacuation procedures.

"I couldn't believe what I was seeing", recounted the pilot, Jimmy Dolittle. "There were two snowmobiles with cargo sleds, a tent, and a bright orange rope that had been laid out on the ice, forming the words, 'HELP-COLD'".

One friend of Prof. Schneider told ecoEnquirer that he had been planning a trip to an ice sheet to film the devastation brought on by global warming.

Well, Ace has updated to say Whoops! Nevermind, though it has enough of a ring of truth to it that I fell for it. They do this stuff all the time. Like getting stuck in ice in the Arctic while filming the devastation of global warming.

Case in point - the Catlin team is wandering around the arctic again this year, averaging 1.7 miles per day. Should make the North Pole by September - 'cept for safety they need to be off the ice by May. Maybe if they hurry.

"Listening to them about Steele is just like taking CNN's word about the tea party."

On some blog or other this weekend, I saw the following: "CNN has hundreds, possibly dozens, of viewers." LMAO when I saw it, because that is actually very close to being true and getting truer every day.

In retrospect, the Jonathan Strong?? seriously
in the Daily Caller was a shot across the bow, who else would know about an entry on pg 1781 of an SEC filing, a remarkedly stupid
action, that kind of explains the status of
the Poizner campaign, "what is that, better
check the cables"

bgates, not to be a nitpicker, but your data are about new diagnoses, while the 20% refers to cumulative cases. Still, it sounds way too high (and "asthma" is one of those things like ADHD that is pretty subjective).

Which is why I multiplied them by 20: 2 new cases/year/10,000 kids x 20 years = 40 cases : 10,000 kids, and even that's
* counting 19-year-olds as "children",
* assuming nobody ages out of the bracket, and
* nobody dies.

Where is the link to Goldberg on Buckley? Dare I hope he is discussing Christo?

For my money, the whole hoohaw about who has or has not "read the bill" is pretty ridiculous. It simply cannot be read by anyone who is not a lawyer who has at his elbow all the volumes containing the many statutory provisions that are referred to throughout. And at that, it would take a long time--a hell of a lot more than 72 hours--to assimilate it all.

Hmmmm... Hot Air has a post up with some really remarkable news. Republicans now lead Dems in the generic congressional ballot by 3%. At this point in time in 94 the Dems were still ahead by 6% in the same poll. The Dem numbers are so bad Gallop never even did a calculation for the impact them having numbers this low.

Still a good talking point, unless it's better to accuse them of purposely voting for everything that becomes uncomfortable. In which case, it should be pointed out that their multi-million dollar crack staffs helped them understand each and every provision.

If I were a doc expecting to be paid something during the first three weeks of April for treating Medicare patients and was told I was to receive nothing, then I'd say that the Maladministration had cut payments to zero. This is a pre-emptive move by the Maladministration to set the level of howling at a louder pitch when the Reps refuse to go along with the proposed "relief" by holding the Dems to their Paygo lies. It's the same theater used to vilify Coburn for holding up additional extended unemployment benefits for the same reason.

I also seem to recall sometime in the distant past (was it last week?) when the Democrat liars forced the CBO to use these very same cuts in payments to doctors for "scoring" the HCR fraud.

Oh, cut it out. When will you people stop letting the MSM play wedge games with Palin and "Conservatives". For Pete's sake, what is she supposed to do, repudiate her erstwhile running mate now? Where is the honor in that?

She is certainly proving that she is a "better man" then he and his campaign staff were, given their dreadful behavior after the election. She is not out slandering anyone. She is not letting bitterness and self-pity lead her into vindictive pettiness. She rises to the occasion. How sad that the GOP "leadership" have less honor or strength than a woman.

She has her eyes on the prize, and that prize would be taking back the House in 2010. She has it right. She needs our support, not this idiotic "conservative purist carp" that so damaged us in '06 and '08.

Palin know it is not a done deal. She know she will have to build momentum though the spring and summer, and that the going will get rough. She knows that she is one of the few people in the country that can stand up to the MSM and the Administration in the maelstrom of libel and lies that is coming.

Scores killed in Moscow by our Islamic enemies, and this nation's government is out attacking "Christian Militia". Palin knows what is up, do you?

This is just the beginning of an all out assault on all decent Americans in the nation who would dare speak their minds and act upon it. Without her to fight back, it is hopeless. The GOP "leadership" will not man up, you can take that to the bank. Look at that twit Steele. What an irresponsible arse.

A bit of history on the Strange New Respect Award, courtesy of the American Spectator a couple of years ago:

More than a quarter century ago, our longtime Washington correspondent (and now senior editor) Tom Bethell began bestowing the Strange New Respect Award on once-reliable conservatives who won liberal praise by adopting liberal policies. Of a sudden, an erstwhile Neanderthal would be treated in the Washington Post as someone who was no longer "simplistic" and "shrill" but rather a figure who had "grown" and showed himself to be "nuanced." In today's Post we see the dynamic is still in play, except the party in question is said to be "maturing." The culprit: Virginia House Speaker William Howell, until recently a staunch opponent of new transportation taxes in Virginia but now hinting he could be flexible on that score. The Post tosses numerous bouquets at him.

"As many political observers see it, Howell is maturing into the leadership role he took on four years ago, which could help the speaker boost his influence."

Once thought "politically aloof and stubborn," he was now using "gentle persuasion" and "diplomacy" to bring "unruly" Republicans around, a great improvement on his "battered image" owing to his earlier "feuding" with pro-tax hiking Democratic governors and "moderate" Republicans.

Gosh, It'd be great if every single Dem lost in November..then we could teach progressives==the hard way==why established procedures should be followed,why it's a good thing to follow the regular confirmation process; why the language in statutes matters and why criminal laws should be clear and fairly enforced, and why abusive of Congressional hearings is a bad thing.

Backup to my assertion regarding phony scoring can be found here. In particular

The reconciliation proposal and H.R. 3590 would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time. Under current law, payment rates for physicians’ services in Medicare would be reduced by about 21 percent in 2010 and then decline further in subsequent years; the proposal makes no changes to those
provisions.

Eventually, the 21% cut BS will be rescinded and Medicare Part B premiums will be raised substantially to cover a good portion of any increase. Hopefully, all the folks in Geezerville will see the increased costs by August. That should leave time for the flames to be fanned before the election.

Tucked away inside a new Washington Post/ABC News poll is a key figure — 72 percent. That’s the percentage of voters who disapprove of the job Congress is doing, and the number hasn’t been that high since — you guessed it — the week before the 1994 election.

A blessed Passover to all my Jewish friends. Somehow, Obama and Seder seem sacriligeous to me. But, what do I know? Jake Tapper on Twitter has a link to a picture of the Seder dinner at the White House. Enough said.

Rick, the condo commandos will take this as their last stand ..These are folks who credibly threatened class action suits when told they couldn't take home the table rolls at the early early bird dinners.